Epicardial Fat Thickness as Cardiovascular Risk Factor and Therapeutic Target in Patients with Rheumatoid Arthritis Treated with Biological and Nonbiological Therapies

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality. Epicardial adipose tissue (EAT) thickness may act as a therapeutic target during treatments with drugs modulating the adipose tissue. We evaluate EAT thickness in RA patients treated with biological and nonbiological disease-modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted with a cohort of 34 female RA patients and 16 controls matched for age and body mass index (BMI). Plasma glucose, basal insulin, plasma lipids, and high-sensitivity C-reactive protein (hs-CRP) were assessed. EAT thickness and left ventricular mass (LVM) were measured by echocardiography. No significant differences in waist circumference (WC), blood pressure, fasting blood glucose, basal insulin, and lipid parameters were found between the groups. The control group showed lower concentrations (P = 0.033) of hs-CRP and LVM (P = 0.0001) than those of the two RA groups. Patients treated with TNF-α inhibitors showed significantly lower EAT thickness than those treated with nonbiological DMARDs (8.56 ± 1.90 mm versus 9.71 ± 1.45 mm; P = 0.04). Women with no RA revealed reduced EAT thickness (5.39 ± 1.52 mm) as compared to all RA patients (P = 0.001). Results suggest that RA patients have greater EAT thickness than controls regardless of BMI and WC.

Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study

“…Interestingly, a decrease in inflammatory macrophage accumulation has been observed in adipose tissue and atherosclerotic lesions following treatment with DPP-4 inhibitors [38,39]. It is thus possible to suggest that sitagliptin might exert an anti-inflammatory effect on EAT as recently found with other anti-inflammatory drugs [40,41].…”

The Effect of Epicardial Fat on the Right and Left Ventricular Function in Subjects with Various Etiological Types of Pulmonary Arterial Hypertension

“…23 Several studies have evaluated the impact of an increased epicardial adipose tissue on the clinical outcomes of patients with autoimmune disorders such as rheumatoid arthritis, psoriasis, or systemic sclerosis. [16][17][18]22 Fatma et al aimed to study the epicardial adipose tissue in patients with rheumatoid arthritis, as well as its effect on the cardiovascular involvement of the systemic disease. Their study found that EFT was higher in patients with polyarthritis (6.6 ± 2.0 mm vs. 5.4 ± 1.8 mm, p = 0.003) and that EFT was linked to left ventricular diastolic dysfunction, hypertension, or duration of the disease.…”

“…Epicardial fat volume, measured by cardiac computed tomography, has been shown to be larger in patients with systemic sclerosis compared to controls, and patients with associated PAH present larger epicardial fat volumes compared to those with systemic sclerosis without PAH. [16][17][18] Also, epicardial fat thickness (EFT) has been associated with the severity of pulmonary disorders that are known for being associated with pulmonary hypertension, and EFT is associated with a higher extent of right ventricular remodeling in patients with chronic obstructive pulmonary disorders. 19 Little is known on the effect of epicardial fat in pulmonary arterial hypertension.…”

Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

“…These abnormalities contribute to the alteration of muscle performances, inducing frailty and disability in RA patients, which, in turn, exacerbate muscle loss and fat deposition [4,31,32]. Moreover, epicardial adipose tissue is increased in RA and produces pro-inflammatory cytokines responsible of an early alteration of myocardial functions, thus leading to an increased risk of CVD [33,34]. Yet, higher visceral fat and a low BMI in patients with RA are implicated in the increased CVD risk (Figure 1) [22,25].…”